REFUGEES- THE REAL STORY

WPHA-WALHDAB Annual Conference May 26, 2016Radisson Paper Valley Hotel, Appleton WI

Kathy Schultz, Health Navigator, World Relief Fox ValleySonja Jensen, RN BSN, Appleton Public Health DepartmentJayne Tebon, RN BSN, Winnebago County Public Health Department

Who is a Refugee?

United Nations High Commission on Refugees (UNHCR) defines a refugee as any person forced to flee their country because of persecution, war or violence. A Refugee has a well-founded fear of persecution because of his:

• Race

• Religion

• Nationality

• Political Opinion

• Social Affiliation

UNHCR Video: “A World in Crisis”

REFUGEE FACTS:

• UNHCR determines Refugee status

• Migrant = Refugee

• Must cross an international border

• Fleeing to preserve life –no options

The Numbers:

• ~25 million Refugees worldwide

• 10.5 million in camps

• <1% resettled annually

• 85,000 resettled in U.S. in 2016, President requesting 100,000 for 2017

Where are the Refugees in Wisconsin coming from?

• Burma (Myanmar)

• Iraq and Syria

• Democratic Republic of the Congo (DRC)

• Cuba

• Somalia

• Pakistan and Afghanistan

UNHCR

• Determines Refugee status, provides aid overseas

US State Dept/Homeland Security

• Security Checks and Clearances

Voluntary Resettlement Agency (VOLAG)

• Responsible for assisting Refugee and establishing self-sufficiency

Pathway to Resettlement

Referral to US State Dept

Resettlement Support Center

1st Security level

Photographs, fingerprints

DHS in-person interview

DHS approvalMedical

screening

Match with VOLAG, cultural

orientation

Final interagency

security check

Multi-level Security Process

What assistance does a Refugee receive from the government when he resettles in the US?

One-time gift of $925

8 months of Medicaid coverage

Foodshare and Cash Assistance (same rules as citizens)

VOLAG Responsibilities

World Relief Fox Valley, Catholic Charities, Lutheran Social Services, International Institute of WI, Pan-African Community Association

• Airport Reception

• Housing/utilities

• Basic household necessities

• Food

• Home orientation

• Clothing

• Community/cultural orientations

• Social Security Registration

• Public Assistance and Medicaid Registration

• School/ESL registration

• Employment assistance

• Establishing with Primary Care

• Health orientation

• Initiate Travel loan repayment

• Initial Refugee Health Screening

IMPORTANCE OF HEALTHCARE

A key factor for a successful resettlement is good healthcare

Proper Diagnosis

Correct treatment –feels better

Improved employment/

education opportunities

Language

Culture

Traumatic History

Medical Philosophy

Barriers Common to all Refugees

Translation

Verify patient understands

translator - Dialects important

Use simple terminology

Ask client to repeat important

information back to you

Body Language

Eye contact, bowing head - respect

Nodding, shaking head - every culture

different. Talk to translator if you sense

confusion, unease

LANGUAGE

• Husbands present with wives

• Uncomfortable with stranger touch

• Medical decisions made by entire family

Gender/Family

• Patient won't ask questions

• Patient assumes provider knows all

• Patient will not volunteer unsolicited information

Relationship with Physician

• Patients consider problems “normal”

• Patients minimize problems in comparison with family/friends

Stoicism

CULTURE

Physical injury-sometimes

improperly/never treated

Sexual assault (women, men, children)-not

immediately obvious or declared

Witness to violence/death of family and friends

Everyone they know has similar experience

- reluctance to discuss/re-live

Internalization of physical and

emotional trauma

TRAUMATIC HISTORY

Preventive Health

• Immunizations

• Preventive Health Screening

• Hygiene, Nutrition and Exercise education

Medications

• Western Medicine concepts

• OTC vs Prescription Medications

• Pharmacy Education

Mental Health

• Cultural Taboos

• History of Trauma

• Stigma

DIFFERENCES IN MEDICAL PHILOSOPHY

What is the role of Public Health?

To ensure timely health screening services are provided to refugees. Timely health screenings will identify health conditions and behaviors that need to be addressed, and help prevent the spread of communicable disease.

What information does Public Health receive prior to the arrival of the refugee?

• Name, DOB, Date of arrival

• Biographical data form

Language Known medical conditions TB screening results Current medications Treatment for parasites

How do we prepare before the first meeting with the refugee?

• Review overseas medical records

• Set up initial PCP appointment

• Coordinate with VOLAG

What happens at the Public Health Initial Refugee Appointment?

Gathering information:

Interpreter

Medical history

Medications

New complaints

Teaching the client:

PCP education

Laboratory testing education

Oral screening

Immunization education

Communicating with the PCP

Before the 1st appointment:

Screenings recommended Urgent issues

After the 1st appointment:

Medications Lab results Referrals to specialists

What happens at the 2nd Public Health appointment for a refugee?

• Lab results

• Medication education

• Immunization teaching

• Referrals to specialists, other PH programs

• Follow up for PH concerns like latent TB

REMEMBER…

These clients are your Patient first, and a Refugee second.

Be patient with your Patients.

Imagine yourself in their situation.

UNHCR Video: “Refugee Stories: Scisa Rumenge, DRC”

On-line Resources

• Cultural Orientation Resource Exchange coresourceexchange.org

• Center for Applied Linguistics culturalorientation.net

• UNHCR unhcr.org• IOM iom.net• US Department of State, Bureau of Population,

Refugees and Migration (PRM) state.gov/j/prm• WI Department of Children and Families

dcf.Wisconsin.gov/refugee